STAND Charm Academy Application

STAND Charm Academy Application

Share your child’s details, program preferences, and required permissions to complete the application.
Student Information
Student Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
School Name
Grade Level
Student Email (optional)
example@example.com
Student Phone (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Program Details
Why would you like your child to join STAND Charm Academy?
Does your child have any allergies or medical conditions?
If yes, please describe the allergies or medical conditions.
Are there any behavioral or learning concerns we should be aware of?
If yes, please describe any behavioral or learning concerns.
Preferred Session
Permissions & Agreements
Do you consent to photo/video release for your child?
I give permission for my child to participate in all program activities.
I agree to pick up my child on time after each session.
Parent/Guardian Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: